Abstract
Objective Intracranial aneurysms treated with endovascular coil embolization may recur. We
investigated the factors affecting aneurysmal recurrence after embolization and effects
of endovascular retreatment within 1 year.
Methods In 3 years, 1,335 patients with 1,385 intracranial aneurysms were treated with coil
embolization. Factors affecting aneurysm recurrence and the effects of endovascular
retreatment were analyzed.
Results Angiography immediately following embolization showed total occlusion in 1,030 aneurysms
(74.4%), neck remnant in 207 (14.9%), and partial occlusion in 148 (10.7%), with a
total peri-procedure complication rate of 4.2%. Overall, 145 patients with 151 aneurysms
recurred within 1 year and the other 1,234 aneurysms remained occluded (89.1%). A
significant (p < 0.05) difference existed in aneurysm size, rupture status, use of stent and immediate
occlusion outcome between the two groups, with significantly (p < 0.05) lower recurrence rates in aneurysms with smaller sizes, no rupture and stent-assistance
coiling. Neck remnant, partial occlusion, coiling without stent assistance, large
and giant aneurysms were significant (p < 0.05) risk factors for aneurysm recurrence during the first year. The rate of recurrence
was 4.7% (11/232) in aneurysms with total occlusion and 35.9% (23/64) in aneurysms
with neck remnant and partial occlusion. Of the 34 recurrent aneurysms, 6 were re-embolized
with detachable coils alone, 12 with stent-assisted coiling, 8 with balloon-assisted
embolization, and the remaining 8 aneurysms with covered stents, resulting in total
occlusion in 28 aneurysms and neck remnant in 6.
Conclusion Recurrence of previously-coiled cerebral aneurysms is significantly affected by aneurysm
size, use of stent and degree of immediate occlusion. Endovascular retreatment with
balloon-or stent-assisted techniques or with covered stents can be safe and effective
for recurrent cerebral aneurysms.
Keywords
intracranial aneurysms - endovascular embolization - recurrence - endovascular retreatment
- complications
